Investigating Viewership of Season 3 of “13 Reasons Why” and the Mental Wellness of Adolescents: Partially Randomized Preference Trial

Abstract

Background A conflicting body of research suggests that additional investigation is needed to understand how globally watched television shows featuring social and mental health issues, such as 13 Reasons Why, might affect adolescents’ mental wellness. Objective This study aims to investigate adolescents’ viewership of the third season of the Netflix drama 13 Reasons Why (13RW-3) and their engagement with show-related content, paying special attention to mental health outcomes and conversational partners. Methods A panel-based research platform operated by the National Opinion Research Center at the University of Chicago recruited 157 adolescents aged 13 to 17 years from its nationally representative pool of participants. Participants answered questions about how they discussed and learned about social and mental health issues portrayed in 13RW-3 (eg, masculine role pressure and sexual assault) and questions about mental wellness (eg, mental health self-efficacy and depression). After the participants completed the survey (T1), they were directed to either watch 13RW-3 as it aired for the first time (intervention group) or not watch 13RW-3 (control group). Approximately one month later (T2), all the participants were asked to complete the postsurvey. Additional survey questions about conversational partners, information seeking because of watching the show, and use of show-related content were included in the intervention postsurvey. Results Our sample (N=157) was 52.2% (n=82) female and 54.8% (n=86) White, with a mean age of 14.99 (SD 1.4) years. At T2, viewers of 13RW-3 spoke about suicide significantly more frequently than nonviewers (P=.007). From T1 to T2, viewers increasingly discussed issues explored by 13RW-3 (P=.002), especially suicide, mental health, and bullying. Adolescent viewers were most likely to speak with friends, and parents were the second most commonly named. Two variables emerged as consistent moderators of conversational choices—having depressive symptoms and being impacted by sexual assault. There was no association between conversational frequency and information seeking around social and mental health issues, and neither mental health self-efficacy scores nor masculine role pressure scores significantly differed between viewers and nonviewers at T2. Conclusions Viewing 13RW-3, a globally watched television show featuring social and mental health issues, led to adolescent conversations and information searches about topics explored by the show. Depressive symptoms and the impact of sexual assault moderated several relationships, guiding participants toward engaging with certain issues and seeking out specific conversational partners. As 13RW-3’s stories drove conversations—and story-driven conversations can raise awareness, reduce stigma, shift attitudes, normalize certain behaviors, and strengthen supportive relationships—potential wellness implications for television shows featuring social and mental health issues are considerable.

Towards the Influence of Media on Suicidality: A Systematic Review of Netflix’s ‘Thirteen Reasons Why’

“…Thirteen publications registered effects in relation to suicide, all of them by using self-reported methods on 13RW viewers. Most studies comprised adolescent samples [ 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], whilst others included young adults [ 50 , 51 , 59 , 60 , 61 ] and even parents or guardians [ 50 , 51 , 53 , 54 , 62 ]. Only two studies were based on clinical populations [ 54 , 55 ] as the rest of them were performed with vulnerable subjects recruited through social networks [ 52 , 58 ], survey firms [ 50 , 51 , 59 , 62 ] or other procedures [ 53 , 56 , 57 , 60 , 61 ].…”

“…The number of viewed episodes was positively correlated with perceived norms about mental illness that, in the end, were related to changes in pro-social mental health behaviors [ 50 ]. In contrast, the only study that used a randomized design linked the increase in the frequency of conversation and information seeking about suicide to presenting depressive symptoms after watching the show [ 57 ].…”

How Americans encounter guns: Mixed methods content analysis of YouTube and internet search data

“…Finally and most importantly, ample work on other public health topics - ranging from suicide prevention and bullying prevention (Uhls et al, 2021), to tobacco and e-cigarette use (Majmundar et al, 2021; Sargent et al, 2003), to vaccine uptake (Getman et al, 2018), to sexual harrassment (Huseth-Zosel et al, 2021), to firearm injury itself (Ojo et al, 2021) - demonstrates that cultural cognitions and behavior can be changed by combining data and narrative in the online world. In work on other public health problems, we see the importance of moving beyond the trope that one narrative is right, and another is wrong.…”

The Relationship Between Psychological Distress and Physical Activity Is Non-linear and Differs by Domain: a Cross-Sectional Study

“…Binge television viewing can reduce sleep quality, which can then contribute to increased distress [ 13 ]. Conversely, exposure to distressing television content has been shown to potentially reduce sources of distress by raising awareness, reducing stigma and shifting attitudes in real-life scenarios [ 14 ]. High amounts of television viewing is associated with increased BMI, cholesterol, blood pressure and triglycerides [ 15 ], and when combined with low PA is associated with earlier mortality [ 16 ].…”